When the government began providing health coverage to millions of older Americans five decades ago, it specifically excluded hearing aids.
Hearing loss among the aged was not a life-endangering medical condition, the reasoning went. Good hearing was not considered essential to good health.
That view has changed. Hearing specialists say the consequences of untreated hearing loss can be substantial, from impaired job performance and damaged relationships to social withdrawal, anxiety, depression and possibly even accelerated dementia.
Yet traditional Medicare still excludes hearing aids for Americans aged 65 and older. And in Oklahoma, the Medicaid program for the poor covers hearing aids only for children up to the age of 20. Private insurance plans vary, but most provide little or no help with hearing aids.
For many people, the cost of seeking treatment can be prohibitive. Today’s advanced digital hearing aids, which provide more hearing enhancement than yesterday’s analog devices, tend to cost from $3,000 to as much as $8,000 per pair when bundled with an audiologist’s diagnostic, fitting and follow-up services.
Little wonder, then, that many people go without treatment. In a few extreme situations, the consequences might be tragic.
Magdiel Sanchez, a 35-year-old developmentally disabled man whose impairments included deafness, was shot and killed by Oklahoma City police in September after he allegedly failed to respond to demands that he drop a length of pipe he was carrying as he approached them. The officers were in Sanchez’s neighborhood responding to a hit-and-run complaint.
Pearl Pearson Jr., a 64-year-old deaf man, was punched in the face and hospitalized in 2014 by an Oklahoma Highway Patrol officer who had pulled him over in Moore after a car chase. The struggle occurred after Pearson reached for something inside his car. Pearson claimed he was trying to retrieve a card explaining his hearing problem.
It is not clear whether hearing aids might have made a difference for either man. But the incidents resonated with at least one hearing-impaired Oklahoman.
After reading about Sanchez and Pearson, Tiara Blue of Milburn said she could imagine something similar happening to her. Blue, 32, has about 50-percent hearing loss in both ears and spent much of her childhood struggling to understand what people were saying to her.
“There have been plenty of instances where I’ve misheard things, usually to comical effect,” Blue said. “But every once and while it’s serious, so I could see myself in that situation where I forget that I’ve got something in my hand and people are yelling at me and I don’t know how to react because I can’t hear what they’re yelling.”
Thousands Go Untreated
Across the nation, about 48 million people above the age of 12 are affected by hearing loss, according to a 2011 study by Johns Hopkins University researchers. An estimated 29 million of them are 60 or older.
In Oklahoma, which accounts for a little more than 1 percent of the nation’s population, that means about 58,000 people are affected by hearing loss, of which about 35,000 are 60 or older.
Research published in the Archives of Internal Medicine estimates that only 14 percent of people who could benefit from hearing aids actually use them.
That projection suggests that nearly 50,000 hearing-impaired Oklahomans who would benefit from hearing aids aren’t wearing them.
Audiologists, otologists and other hearing specialists cite several reasons for the prevalence of untreated hearing loss. Chief among them are denial and stigma. Many people, they say, associate hearing loss with old age and physical decline and aren’t ready to admit that they are affected. Others may acknowledge the problem, but don’t want to wear devices that others might notice.
Larry Engelmann, an audiologist who operates an Oklahoma City hearing clinic, views it in generational terms.
“The generations older than 40, they have a tendency to associate hearing loss with old age and deafness and large hearing aids,” Engelmann said.
“Today’s hearing aids are getting smaller and smaller, almost to the extent that you can’t see them,” he said. “ So I’m observing a change in social opinion because of technology…. To younger people, there is less avoidance, less social stigma.”
High Cost of Relief
Engelmann and other hearing specialists concede that cost can be a major barrier, too.
A 2016 study by the National Academy of Sciences cited an average cost of $4,700 per pair for hearing aids. Engelmann said the least expensive hearing aids he would recommend for his patients cost about $3,000 per pair.
Hearing aids that sell at much lower prices tend to be based on older technology and lack the features found in today’s advanced digital devices.
The cheapest fall into a category called personal sound amplification devices. PSADs are not regulated by the Food and Drug Administration and can’t be legally described as hearing aids.
Retail hearing aid dealers, who receive less training than audiologists, might be able to provide quality hearing aids at less cost. The Oklahoma State Health Department said it has licensed 160 dealers across the state.
Hearing aid dealers are required to have a high school diploma and pass a state-administered exam. Audiologists must receive a bachelor’s degree and complete four years of graduate education.
Congress, meanwhile, enacted a law in August that created a new category of over-the-counter hearing aids for people with mild to moderate hearing loss. It will take a year or more for the FDA to draft rules regulating their sale, but they are expected to cost less than the higher-end devices provided by audiologists.
For Amy Buckles, a 62-year-old registered nurse in Oklahoma City, the high cost of hearing aids has deterred her from getting any for more than 20 years.
Buckles said she has moderate hearing loss in both ears. She used to work in an intensive care unit, a job she said she could no longer do because of her hearing problems. She now works as a clinical director for a home health care nursing service and has found ways to compensate for her hearing loss at work.
“I’m very good at reading lips. The nurses that I work with are pretty used to that,” Buckles said. “The biggest problem I have at work is sometimes on the telephone…. Sometimes people have to repeat.”
Buckles said her on-the-job problems remain manageable. She worries more about the effect of her hearing loss on social relationships. She has to ask friends to repeat themselves and has difficulty with group conversations. She has given up going to theatrical performances and has to choose her seat carefully in movie theaters.
“My really good friend said, ‘I don’t think you realize how much you’re missing out on.’ She keeps saying that. I’m missing out on something.”
Medicare will help pay for diagnostic hearing exams if ordered by a doctor. But for the majority of people who opt for traditional “Part B” medical coverage, it excludes hearing aids from the list of covered medical devices. (People who choose optional “Part C” coverage, similar to an HMO, might receive limited help with hearing aids, depending on the plan they pick.)
For younger, lower-income people who qualify for Medicaid, coverage of hearing aids varies from state to state. Oklahoma is one of 25 states that provide little or no assistance for adults.
Employer-provided health plans and individual health policies typically provide little to no coverage of hearing aids, either.
For the thousands of Oklahomans who fall between those cracks, financial help is available through a handful of government and charitable programs.
One of the more generous ones pays up to $4,450 per pair for Oklahomans whose hearing loss interferes with their ability to work.
The program is operated by the Oklahoma Department of Rehabilitative Services and available to people with incomes well into high five figures. Last year it provided hearing aids to 228 people, but program manager Jonathon Cook said it had the capacity to serve many more.
“It seems like no one is aware we exist. We’re kind of the best-kept secret,” Cook said. “We have people who say, ‘If I knew about this, I would have come to you a decade ago.’”
Audiologist Jillian Detwiler, who oversees the Cabaret Hearing for Seniors Program, said she hears similar sentiments from low-income patients whom she fits with advanced hearing aids for only $100.
“We get a lot of tears. We get a lot of thank-you notes. We get a lot of hugs,” Detwiler said.
About six months ago, Detwiler’s crew at the John W. Keys Speech and Hearing Center in Oklahoma City fitted an elderly woman with a pair of good hearing aids. The woman had stopped attending church, stopped playing bridge and even refrained from joining family members for meals.
“She came back for a follow-up appointment. She had these giant tears in her eyes and she said, ‘I went to church for the first time in two years. I had lunch with my family, and people asked me questions and I could respond,’“ Detwiler said. “It’s that kind of person – that’s why we do this.”
Quality of Life
According to hearing specialists, the architects of Medicare and Medicaid were less aware of the damage that poor hearing inflicts on the emotional well-being and quality of life of millions of Americans.
Engelmann, the Oklahoma City audiologist, said he has seen many couples become increasingly alienated because of one or both partners’ hearing loss.
“I almost felt like a marriage counselor because there would be such a barrier created between a husband and a wife,” Engelmann said.
He described a man and woman in their 40s who came to him because of the wife’s untreated hearing loss. It was winter; both were wearing heavy coats. When the woman got up from her chair in the office waiting room, her husband said, “Would you like me to take your coat?”
“As soon as he finished that sentence, she had fire in her eyes,” Engelmann recalled. “She whipped around real fast … and said, ‘I don’t have time to go get a Coke. I’m here to have my hearing tested!’”
The man looked at Engelmann and pointed a finger at his wife. “This is exactly why we’re here. She does this all the time and I’m sick of it.’”
Blue, the Milburn woman who has struggled with hearing loss since infancy, said her family’s poverty and limited insurance coverage prevented her from obtaining top-quality hearing aids until she was in college. She wound up spending scholarship money to help pay for them.
Blue is an aspiring author and has taught English at Murray State College in Tishomingo. She said she has adapted to her hearing loss over time, but recognizes that it has limited her socialization skills, perhaps permanently.
“When I was younger, I never learned things like small talk. It passed right over me. It made me shy,” Blue said. “I still struggle with small talk and interacting with people in a normal way. … It can make me look insensitive or awkward.”
Buckles, the Oklahoma City nurse with untreated hearing loss, said she has seen more extreme quality of life effects in some of her home heath-service patients who become increasingly isolated as their hearing worsens. She said he understands their tendency to avoid social contact.
“It’s like failure slapping you in the face every time you have to ask, ‘What did you say?’”